Remission of anorexia nervosa after thyroidectomy: A report of two cases with Graves' disease and anorexia nervosa

Anorexia nervosa is a potentially fatal eating disorder with a strong psychological component. There is still some disagreement over whether the disease is primarily psychological with physical changes as a result of malnutrition, or a physical disease that results in behavioral changes [1,2]. It has recently been demonstrated that peptide YY (PYY), glucagons-like peptide 1 (GLP-1) and ghrelin behave in opposite ways between patients of anorexia nervosa and constitutionally thin subjects [3], suggesting that endocrine changes precede malnutrition in anorexia nervosa. However, the actual endocrine mechanism behind anorexia nervosa is not known. Here we present two cases of young women with Graves' disease and anorexia nervosa who underwent surgery for Graves' disease and concomitantly experienced remission of anorexia nervosa. These cases suggest that an anorexigenic endocrine factor is secreted from the thyroid gland. A review of the literature is discussed.20 year old female (upon admission). Diagnosed of Graves' disease the previous year but presented allergic urticaria to both propylthiouracil and methimazole. Thyroid function was controlled with potassium iodide until surgery. She had a history of anorexia bulimia and was hospitalized for cognitive behavioral therapy at age 18. Her eating behavior was stable as well as her thyroid function at the time of surgery at age 20. There is no record of the use of SSRIs in the treatment of anorexia nervosa. Her height was 154.2 cm and body weight was 53 kg (BMI 22.3) at the time of surgery. Post operatively she was placed on 50 mcg of levothyroxine daily which maintained her thyroid function within normal levels. There was no relapse of her anorexia bulimia and her body weight was maintained over the next five years.26 year old female (upon admission). Diagnosed of Graves' disease at age 26 but presented with liver dysfunction with methimazole and mild neutropenia with propylthiouracil. Thyroid function was controlled wi